Nov 10, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory Pathology
Progressive pathologists and lab leaders are looking ahead to the day when fee-service reimbursement is replaced by budgeted payment and similar arrangements
SAN DIEGO, CALIFORNIA—More than 100 clinical laboratory owners and lab executives gathered here this week for the annual meeting of the California Clinical Laboratory Association (CCLA). Because the medical laboratory testing marketplace in California is often a bellwether for trends that go national, the presentations were timely and of universal interest to lab professionals working in other regions of the United States.
The membership of CCLA certainly reflects the broader changes happening in the clinical laboratory industry nationally. Whereas a decade or two ago, the majority of CCLA members were independent lab companies providing routine lab testing services to office-based physicians, today the larger share of CCLA members are associated with lab companies that offer patent-protected or proprietary specialty tests. (more…)
Jul 9, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Scheduled to launch in early 2015, the Health Care Cost Institute’s free online tool will give consumers access to data on provider prices and quality
It’s a significant sign of the times when three of the nation’s biggest health insurance companies agree to share data on healthcare prices and utilization specifically so that consumers can access this information. This will advance price transparency. It will also put more pressure on clinical laboratories to make it easy for consumers to see the prices of medical laboratory tests in advance of services.
This new price-transparency project includes Aetna (NYSE: ATE), UnitedHealthcare (NYSE: UNH), and Humana (NYSE: HUM). The three health insurers are partnering with the Health Care Cost Institute (HCCI), a nonprofit organization that maintains a database on healthcare cost and utilization.
The insurers will share healthcare price data. HCCI plans to provide the general public free, online access to this information, beginning in early 2015. (more…)
Jun 18, 2014 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
In Massachusetts, a 1,000-physician group gets 70% of revenue from capitated payments, motivating the physicians to reduce unnecessary utilization of medical laboratory tests
Accumulating market evidence indicates that unnecessary utilization of medical laboratory tests—a problem bemoaned by pathologists for decades—may finally be addressed by an unlikely source: ordering physicians! Such a trend would have both positive and negative consequences for clinical laboratories throughout the United States.
What motivates physicians, on their own initiative, to reduce the unnecessary utilization of medical laboratory tests are changes in how they are paid. Many private health plans are reimbursing office-based physicians using global payment arrangements, such as capitation. (more…)
Apr 14, 2014 | Compliance, Legal, and Malpractice, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Leaders from ACLA, AdvaMedDx, CAP, NILA will be at Executive War College on April 29-30 for first medical lab industry debate about the best and worst of the new law
Clinical laboratories will face new financial challenges following passage of a new federal law two weeks ago that makes deep changes in the way Medicare officials will establish prices for the Medicare Part B Clinical Laboratory Fee Schedule (CLFS). Many medical laboratory administrators, hospital lab managers, and pathologists remain unaware of the significant negative financial impact this law will have on their lab’s revenue and fiscal stability.
On April 1, President Barack Obama signed H.R. 4302: Protecting Access to Medicare Act of 2014. The law’s primary purpose is to extend the Sustainable Growth Rate (SGR) formula for 12 months. The House had passed the bill on the previous Thursday and the Senate passed the bill on the following Monday, March 31. (more…)
Dec 4, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Managed Care Contracts & Payer Reimbursement, Management & Operations
Radiology and pathology associations are supporting a new bill in Congress to address self-referrals made by urologists
Criticism is mounting against urologists who refer their patients to radiation providers in which they have an ownership relationship. This criticism is strikingly similar to concerns that pathologists and others have expressed about situations where urologists refer their patients to anatomic pathology laboratories in which they have an ownership relationship.
Study about Radiation Therapy Referrals Published in NEJM (more…)
